Aktuelle Epidemien in Afrika

[Birgitt]

TUNGA PENETRANS ­ UGANDA (02): COMMENT
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Date: Sat 6 Nov 2010
From: Richard J. Pollack, Ph.D.
<rpollack@hsph.harvard.edu>


Tungiasis in Uganda: Comment
----------------------------
Tunga penetrans are fleas (insects of the order
Siphonaptera), and are commonly referred to as
chigoe fleas and sometimes as jigger fleas. In
contrast, chiggers are mites. Adult chigoe fleas
do burrow into skin, but they most often invade the skin of the feet.

The MSNBC report seems considerably confused as
to the actual cause and extent of this
'epidemic.' These fleas neither invade beyond the
skin nor breed within a person. The lesions can
become secondarily infected and necrotic.

Whereas some of these cases may, indeed, be
burdened with an infestation of the chigoe flea,
some others may suffer from infestation by the
Congo floor maggot (_Auchmeromyia senegalensis_)
as well as diverse other causes.

--
Richard J. Pollack, Ph.D.
<rpollack@hsph.harvard.edu>
Harvard School of Public Health and Boston University
and
IdentifyUS LLC
<http://identify.us.com>

[ProMED thanks Richard J. Pollack for his
comment. We agree that the original posting is
confusing and we still doubt that a large number
of death can be due to Tunga penetrans and indeed
that it can course an outbreak as described. ­ Mod. EP]

[Birgitt]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (27)
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In this update:
Africa
[1] Cholera - Zimbabwe (Manicaland)
[2] Cholera - Ghana (Eastern region)


******
[1] Cholera - Zimbabwe (Manicaland)
Date: Mon 8 Nov 2010
Source: Channel 6 News, BNO News report [edited]
<http://channel6newsonline.com/2010/11/n ... -hundreds/>


At least 16 people have died and hundreds more are ill after a fresh
cholera outbreak in eastern Zimbabwe, according to state run media on Mon 8
Nov 2010. The state-controlled Zimbabwe Broadcasting Corporation reported
that the epicenter of the latest cholera outbreak is in Marange District of
Manicaland Province, killing at least 16 people since October 2010.

"13 were community deaths where the people died at their homes and 3 were
institutional deaths," said Zimbabwean deputy minister of health and child
welfare, Douglas Mombeshora.

Mombeshora said another 669 people are suspected to be suffering from
cholera, while 86 others are confirmed to have cholera. Most of the cases
are reportedly linked to illegal diamond mining activities in Chiadzwa,
where miners live in unhygienic conditions. The new outbreak comes only
months after most of the country's ongoing cholera epidemic appeared to
have passed. The epidemic, which began in August 2008, killed at least 4300
people and sickened up to 100 000 others.

--
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[A map showing the administrative regions of Zimbabwe can be accessed at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. The
HealthMap/ProMED-mail interactive map of Zimbabwe can be seen at
<http://healthmap.org/r/0frf>. - Sr.Tech.Ed.MJ]

******
[2] Cholera - Ghana (Eastern region)
Date: Sat 6 Nov 2010
Source: Ghana Broadcasting Corporation (GBC) [edited]
<http://gbcghana.com/index.php?id=1.169442>


The East Akyem municipal director of health services, Dr Ekow Kwaitoo, says
all necessary interventions are being put in place to control the cholera
outbreak in the area. He asked the public not to panic since the various
health centres in the municipality have been asked to strengthen their
surveillance.

Dr Kwaitoo who was speaking to Radio Ghana at Kyebi said 56 suspected cases
have so far been recorded without death since the Health Directorate
detected the problem a fortnight ago [the fortnight is a unit of time equal
to 14 days. The word derives from the Old English feowertyne niht, meaning
"14 nights" <http://en.wikipedia.org/wiki/Fortnight>. - Mod.LL]. Among the
places affected he said are Asiakwa, Asikam, Adadientem, Potroase, Kyebi,
and Apapam which is leading.

Dr Kwaitoo described cholera as a disease that occurs during the rainy
season and advised the public to keep their environment clean to check any
further outbreak. The East Akyem municipal chief executive, Simon Peter
Asirifi, said Epidemic Implementation Committee including NADMO [National
Disaster Management Organisation], Environmental Health, Water and
Sanitation Committee, as well as the Information Services Department is on
the ground to assist the Health Directorate control the outbreak.

The acting matron of the kibi Government Hospital, Augustina Tsekpetse,
said only 4 out of the 56 victims were still in the hospital on Friday [5
Nov 2010] while all the rest had been treated and discharged.

--
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[The eastern region of Ghana can be seen on the map at
<http://www.un.org/Depts/Cartographic/ma ... /ghana.pdf>. The
HealthMap/ProMED-mail interactive map of Ghana can be found at
<http://healthmap.org/r/0frg>. - Sr.Tech.Ed.MJ]

[Birgitt]

Benin - Darminfektionen
08.11.2010

Risiko für Durchfallerkrankungen landesweit. Ende Oktober berichtete UNICEF von einem Cholera-Ausbruch mit bisher über 800 Erkrankten und mehreren Todesfällen. Aufgrund starker Regenfälle sind derzeit etwa zwei Drittel des Landes überflutet. Nach einer Pause von vier Jahren kam es 2008 erstmals wieder zu 6 Fällen von importierter Polio. 2009 waren es 21 Erkrankungen. Hygiene und Impfschutz für Polio und ggf. Cholera beachten. / Quelle: crm
_______________________________

Kamerun - Darminfektionen
08.11.2010

Risiko für Durchfallerkrankungen landesweit. Auch Cholera-Ausbrüche kommen ganzjährig vor, insbesondere im Norden des Landes (Grenzgebiet zum Tschad), aber auch in der West- und der Littoral-Region. Nach Regierungsangaben sind 8.528 Menschen an Cholera erkrankt und 559 gestorben. Es wird vor einer Ausbreitung des Ausbruches aus dem Norden des Landes in Nachbarländer gewarnt. Hygiene beachten, bei Reisen in die Region ist eine Impfung zu empfehlen. Polio Wildvirus Typ 1 und 3 wurde seit 2003 aus Nigeria mehrfach importiert. Letztes Jahr wurden zum ersten Mal seit 2007 wieder 3 Erkrankungen diagnostiziert. Hygiene und Impfschutz (Polio) beachten. / Quelle: crm
________________________________

Kongo, Demokratische Republik - Infektionskrankheiten
08.11.2010

Hohes Risiko für Darminfektionen, speziell Durchfallerkrankungen einschließlich Ruhr und Cholera landesweit. In einem von Ärzte ohne Grenzen errichteten Camp für Binnenflüchtlinge im umkämpften Gebiet Süd-Kivu brach Mitte August Cholera aus. Auch vom Tanganyika See (Kalemie) wird ein Cholera-Ausbruch mit mehreren Todesfällen gemeldet. Alle Formen der Virushepatitis kommen im Land vor. Polio durch reimportiertes Wildvirus Typ 1 wurde 2006 wieder bei 13 Erkrankten nachgewiesen. 2008 erkrankten 5 und 2009 3 Patienten. Anfang November wurde ein Ausbruch von mindestens 120 Erkrankten und 48 Todesfällen gemeldet. Angesichts dieser hohen Sterberate ist von einem starken Underreporting auszugehen. Auffällig ist weiterhin, das die Erkrankten zum großen Teil junge Erwachsene und kaum kleine Kinder sind. Es sind große Impfaktionen geplant, in denen alle Bürger einen monovalenten oralen Impfstoff erhalten sollen. Der Erreger wurde wahrscheinlich aus Angola importiert. Schlafkrankheit und Tollwut sind weit verbreitet, Risiko auch für örtliche Auftritte von Pest, vor allem im NO des Landes, für Affenpocken sowie viralen hämorrhagischen Fiebern. / Quelle: crm
_______________________________

Nigeria - Darminfektionen
08.11.2010

Risiko für Durchfallerkrankungen landesweit. Ein Cholera-Ausbruch hat laut Regierungsangaben etwa 1.500 Todesopfer gefordert. Fast 38.000 Erkrankungen wurden in 15 der Bundesstaaten Nigerias registriert.. Auch die Hauptstadt ist betroffen. Schwere Überflutungen und die Vertreibung von großen Menschenmengen erschweren die Lage. Hygiene beachten, Impfung ist zu empfehlen. / Quelle: crm
_______________________________

Senegal - Malaria
08.11.2010

In der Hauptstadt Dakar werden vermehrt Malaria-Fälle diagnostiziert. Allein in einem Gesundheitszentrum wurden von Juli bis Oktober dieses Jahres 13.813 Patienten behandelt. Bisher gibt es keine Todesfälle und es sind genug Medikamente vorhanden. Schutz vor dämmerungs- und nachtaktiven Stechmücken beachten, außerdem wird eine Chemoprophylaxe empfohlen! / Quelle: crm

[Birgitt]

Senegal - Malaria
08.11.2010

In der Hauptstadt Dakar werden vermehrt Malaria-Fälle diagnostiziert. Allein in einem Gesundheitszentrum wurden von Juli bis Oktober dieses Jahres 13.813 Patienten behandelt. Bisher gibt es keine Todesfälle und es sind genug Medikamente vorhanden. Schutz vor dämmerungs- und nachtaktiven Stechmücken beachten, außerdem wird eine Chemoprophylaxe empfohlen! / Quelle: crm

[Birgitt]

HEPATITIS C - EGYPT
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Date: Mon 8 Nov 2010
From Los Angeles Times [edited]
<http://latimesblogs.latimes.com/babylon ... gures.html>


Egypt: Hepatitis C infection reaches alarming figures
-----------------------------------------------------
Egypt's spiralling threat of hepatitis C virus (HCV) -- already the highest
incidence rate in the world -- is alarming researchers who fear that a
potential epidemic of the bloodborne disease could spread across the most
populous Arab country. The findings of a recent study published in the
Proceedings of the National Academy of Sciences [Evidence of intense
ongoing endemic transmission of hepatitis C virus in Egypt. By Miller FD,
Abu-Raddad LJ. Proc Natl Acad Sci USA. 2010 Aug 17;107(33):14757-62. Epub
2010 Aug 9;
<http://www.pnas.org/content/early/2010/ ... hort?rss=1>]
showed that more than 500 000 new HCV infection cases occur in Egypt every
year. Much of the problem behind the soaring infectious rates is poor
health care oversight and erratic medical hygiene.

"Nearly 7 out of every 1000 Egyptians acquire HCV infections every year.
This is the highest level of HCV transmission ever recorded at a national
level for a disease transmitted by use of non-sterile medical instruments,"
says Dr F DeWolfe Miller, lead author of the study.

Prevalence of hepatitis C in Egypt dates back to the 1970s. It was then
that health authorities in the Nile Delta and Upper Egypt were injecting
patients with tartar emetic to stop the spread of the waterborne disease
known as bilharzia. But many of the needles were unsterilized, causing HCV
to spread to thousands of Egyptians.

Nowadays, many blame the government for not halting the virus'
proliferation throughout the country of about 80 million people. The
Egyptian National Committee on Viral Hepatitis states that 9.8 per cent of
Egyptians are HCV infected, whereas doctors and researchers claim that the
real figure is between 15 and 20 per cent.

"Most HCV patients come from Egypt's most rural and poorest areas and they
rely on the medical insurance programs," said Dr Lotfi Wanees, an expert on
hepatitis. "Medication cost for every hepatitis C patient stands at an
average of 70 000 Pounds [USD 12 250] and the government has failed to
provide this sum for most of the patients."

He added: "There are also the deals signed between the Ministry of Health
and medicine companies. Many virus C medicines produced by Egyptian
pharmaceutical firms are not verified in the West and proved to be
inefficient. But they are still being prescribed to patients and the
government pays millions of pounds to purchase them."

According to Wanees, the "community acquired" virus has also been
accompanied by culture and literacy problems, as many of the poor,
uninsured patients resort to superstitious and primitive medical
substitutes, which worsen their cases.

Complications of hepatitis C lead to liver cirrhosis or liver failure. Many
people infected with the virus have no symptoms and are only diagnosed when
liver damage appears many years later.

[byline: Amro Hassan]

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communicated by:
HealthMap Alerts via ProMED-mail
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[Hepatitis C is a contagious liver disease that results from infection with
hepatitis C virus. It can range in severity from a mild illness lasting a
few weeks to a serious, lifelong illness. Hepatitis C is usually spread
when blood from a person infected with hepatitis C virus enters the body of
someone who is not infected.

Hepatitis C can be either "acute" or "chronic". Acute hepatitis C virus
infection is a short-term illness that occurs within the 1st 6 months after
someone is exposed to hepatitis C virus. For most people, acute infection
leads to chronic infection. Chronic hepatitis C is a serious disease than
can result in long-term health problems, or even death. There is no vaccine
for hepatitis C.

At least 11 different genotypes of hepatitis C virus have been
differentiated which tend to be geographically restricted in their
prevalence. Hepatitis C virus genotype 4 has predominated in Egypt.
Unfortunately patients infected with hepatitis C virus genotype 4 tend to
respond poorly to interferon alpha, one of the most effective treatment
options available for control of HCV infection.

The HealthMap/ProMED-mail interactive map of Egypt can be accessed at
<http://healthmap.org/r/008F>. - Mod.CP]

[Birgitt]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (28 )
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*******

Cholera - Cameroon
Date: Thu 11 Nov 2010
Source; Cameroon Tribune [edited]
<http://allafrica.com/stories/201011110942.html>


Close to 10 000 cases have been reported, with 597 deaths in the country as
at 8 Nov 2010. The situation of the current cholera epidemic continues to
raise fears in the country. The recent outbreak is one of the most severe
in decades. Over the past 2 days, new cases have been reported in the Far
North Region. According to reports from the Department of Disease Control
in the Ministry of Public Health, a total of 9395 cases of cholera have
been registered all over the country with 597 deaths, giving an average
death rate of 6.35 per cent.

The Far North Region has registered a total of 8830 cases with 573 deaths.
The North Region comes next with 328 cases and 17 deaths. Of late, 34 new
cases have been registered in the region and all of them in the Figuil
Health District. The Littoral Region has registered 204 cases with 5
deaths. Two new cases have been registered within 4 days in the region and
no new deaths reported. Meanwhile, in the Centre Region, 31 cases in all,
with 4 deaths were reported. Two new cases have been announced in the
Nkolndongo Health District in Yaounde. In all, 6 regions, notably the Far
North, North, Littoral, Centre, West and Adamaoua are affected, and 58
health districts out of the 179 in the country have been hit by the cholera
epidemic.

[byline: Elizabeth Mosima]

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[Birgitt]

LASSA FEVER - SIERRA LEONE (04): (NORTHERN)
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Date: Thu 11 Nov 22010
Source: News24, SAPA report [edited]
<http://www.news24.com/SouthAfrica/News/ ... e-20101111>


A South African civil engineer has become the 3rd person to die in an
outbreak of Lassa fever in northern Sierra Leone, a health ministry
official said on Thursday [11 Nov 2010].

While the acute viral haemorrhagic fever causes some 5000 deaths annually
in west Africa, according to World Health Organization figures, it has
usually only affected the eastern part of Sierra Leone, and this case has
sparked fears the disease may be spreading.

"The death of the South African shows the active infection rate of the
Lassa fever virus in the district and brings to 3 the number who have now
died," said Amara Jambai of the ministry's disease prevention and control
directorate.

The South African civil engineer, who worked for the Geneva-based
bio-energy company Addax, died on Wednesday [10 Nov 2010] after contracting
the virus in September [2010].

"Lassa fever cases in Makeni are worrying because the area has not known of
any prevalence of the disease in recent times, and the disease is very
infectious, and its case fatality [rate] is always high," said Jambai.

Lassa fever was identified in the northern Nigerian village of Lassa in
1969 and is endemic in parts of west Africa, including Liberia, Guinea and
Senegal. The virus is spread through contact with rat urine or faeces and
later between humans through contact with bodily secretions.

Two people died in October [2010] in Makeni, including a woman (who ran a
restaurant selling rat meat) and her 6 year old son.

Of the 153 cases recorded nationwide in the 1st 10 months of the year, 48
people have died, according to health officials.

--
communicated by:
Thomas James Allen
<tjallen@pipeline.com>

[This report records another fatal case of Lassa fever in the vicinity of
the village of Makeni in northern Sierra Leone. Readers are referred to the
proceeding reports in this thread for details of the outbreak. It seems
likely that the South African civil engineer came into contact with
_Mastomys_ rodents or their excreta during the course of his employment and
tragically died.

About 80 per cent of human infections are asymptomatic; the remaining cases
have severe multisystem disease, where the virus affects several organs in
the body, such as the liver, spleen, and kidneys. The incubation period of
Lassa fever ranges from 6-21 days. Further information can be obtained at
<http://www.who.int/mediacentre/factshee ... index.html>.

A photograph of a _Mastomys_ multimammate rat can be viewed at
<http://en.wikipedia.org/wiki/File:Mastomys.jpg>.

The HealthMap/ProMED-mail interactive map of Sierra Leone is available at
<http://healthmap.org/r/0bj5>. - Mod.CP]

[Birgitt]

LEISHMANIASIS, VISCERAL - SUDAN (03): (SOUTHERN)
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Date: Thu 11 Nov 2010
Source: Relief Web.com, Agence France-Presse (AFP) report [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... 0&RSS20=FS>


Visceral leishmaniasis disease kills 260 in south Sudan
-------------------------------------------------------
A rare parasitic disease has killed 260 people in southern Sudan in
the past year, a figure that is threatening to double in the
coming months, the World Health Organization (WHO) said on Thursday
[11 November 2010].

"Since September last year [2009], 260 people have died of kala azar
in southern Sudan, most of them children who suffer from
malnutrition," said Abdinasir Abubakar, head of the WHO in southern
Sudan.

Kala azar, or visceral leishmaniasis, is a rare tropical disease
contracted by the bite of a sand fly [Phlebotomus], endemic in some
parts of southern Sudan.

Last week [week ending 7 November 2010], the aid agency Medecins Sans
Frontieres (Doctors Without Borders) warned that southern Sudan faced
a "serious outbreak" of the tropical disease, especially in the remote
states of Jonglei and Upper Nile. "The most affected areas are (still)
Jonglei and Upper Nile,particularly at Ayoka and Old Fangak (Jonglei)
where more than half the cases are concentrated," said the WHO official.

More than 9000 cases have been identified since September 2009, and
that could represent [just] the tip of the iceberg, the authorities
say. "We believe that the number of cases will double over the next 5
months," said Abubakar.

Visceral leishmaniasis, which attacks the immune system, usually
manifests itself in patients with fever, weight loss and an enlarged
spleen and liver.
About 500 000 cases are diagnosed each year, more than 90 percent of
which are found in India, Bangladesh, Nepal, Sudan, and
Brazil,according to the WHO.

--
Communicated by:
HealthMap Alerts via ProMED-mail
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[Despite earlier indications of a decline in kala azar cases in
Jonglei state <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2570907/>,
the information available from the current report indicates an
increase in cases from the previous years with at least 9000 cases
reported in the past one year from the states of Jonglei and Upper
Nile. This highlights the need for a review so as to update the
current national interventions for controlling the disease.

The World Health Organization recommends endemic countries to develop
programs to reduce the disease incidence through: facilitating early
diagnosis and prompt treatment; supporting control of sand fly
populations through residual insecticide spraying of houses and the
use of insecticide-impregnated bed-nets; providing health education
and producing training materials; detecting and containing epidemics
in the early stages; and providing early diagnosis and effective
management for leishmaniasis/HIV co-infections:
<http://www.who.int/leishmaniasis/surveillance/en/>

The HealthMap/ProMED-mail map of Southern Sudan showing Jonglei and
Upper Nile States is available at:
<http://healthmap.org/r/00_c> <http://healthmap.org/r/00_c>. - Mod.JFW]

[Birgitt]

Ägypten - Hepatitis C
15.11.2010

Experten schätzen, das 15-20% der Bevölkerung Träger des Virus für die Leberentzündung sind; ca. 500.000 Menschen erkranken jährlich daran. Die Anfänge dieser Epidemie sind auf die Behandlung der Bilharziose in den 1970er Jahren zurückzuführen; wo unsterile Nadeln verwendet wurden. Kontakt mit unsauberem medizinischen Material, aber auch Tätowierungen, Piercings etc. sollten vermieden werden. / Quelle: crm
________________________________

Kongo, Republik - Polio
15.11.2010

Anfang November wurde ein Ausbruch von mindestens 226 Erkrankten und fast 100 Todesfällen gemeldet. Angesichts dieser hohen Sterberate ist von einem starken Underreporting auszugehen. Auffällig ist weiterhin, das die Erkrankten zum großen Teil älter als 15 Jahre und kaum kleine Kinder sind. Es sind große Impfaktionen geplant, bei denen alle Bürger einen monovalenten oralen Impfstoff erhalten sollen. Das Virus wurde wahrscheinlich aus Angola importiert. Hygienemaßnahmen und Impfung beachten. / Quelle: crm

[Birgitt]

UNDIAGNOSED DEATHS - UGANDA (AGAGO, ABIM), REQUEST FOR INFORMATION
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Date: Mon 15 Nov 2010
Source: New Vision (Uganda) [edited]
<http://www.newvision.co.ug/D/8/12/738335>


A total of 13 people have been reported dead in Abim and Agago
districts, following an outbreak of a strange disease in Abim. 20
cases have been reported in Abim district, out of whom 8 have already
died. In neighbouring Agago district, 5 cases have been reported in
the sub counties of Omiya P'Chua and Paimol, which border Abim
district. Emmanuel Okech, an official from the Abim district health
office, said out of the 20 cases, 8 have died, 2 have been
quarantined, and another 10 have been discharged after their
conditions improved.

According to Okech, the affected persons have high fever, vomit blood,
pass bloody stools, and also bleed from other openings like the nose
and ears. "The victims usually die between 3 and 5 days and are
suspected to be highly contagious," Okech said.

Last week [week ending 14 Nov 2010], a team from the World Health
Organization and the Ministry of Health went to Abim and are
investigating the disease. According to Okech, samples were taken to
the Uganda Virus Research Institute, but there is still no clue as to
what disease is affecting the people there.

"We were suspecting viral hemorrhagic infection, but results from the
Uganda Virus Research Institute have ruled out Ebola, Marburg, and
Lassa," Okech said. He said samples from the affected persons have now
been flown to the Centers for Disease Control & Prevention (CDC) in
Atlanta.

On [Tue 16 Nov 2010], the district health officer of Agago district,
Dr Emmanuel Otto, announced that 5 people had died in Paimol and Omiya
P'Chua from infections similar to those reported in Abim. Dr. Otto
said he was also expecting a team of doctors from the World Health
Organization and the Health Ministry in Agago to go to the affected
sub-counties and conduct tests to ascertain the nature of the disease.

According to Emmanuel Okech, more than 10 percent of patients treated
in Abim Hospital are from neighboring Agago district, raising
suspicions that the 5 who died in Agago could have contracted the
disease while they went for treatment in Abim Hospital. Meanwhile,
authorities in Abim district have put up an isolation center for those
suspected to have contracted the disease.

According to Abim district chairman Norman Ochero, the district health
sector and its partners have pooled resources to set up an isolation
center in Abim Hospital and Morulem Health Centre. "We have also
advised people to maintain personal hygiene and to desist from
handshakes," said Ochero [but see last comment below].

[Byline: David Labeja, Sam Oboke]

--
Communicated by:
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[This undiagnosed illness in northeastern Uganda has a clinical
presentation that suggests viral hemorrhagic fever. However, tests
done at the Uganda Virus Research Institute have ruled out Ebola,
Marburg and Lassa fevers. The differential diagnosis is wide and
includes other viral infections, particularly arbovirus infections;
bacterial infections such as typhoid fever and shigellosis;
rickettsial diseases; and parasitic infections such as malaria. This
cluster definitely warrants a comprehensive epidemiological
investigation, and further information on the cause of this evolving
outbreak will be appreciated.

A map showing Abim and Agago districts in northeastern Uganda can be
seen at <http://en.wikipedia.org/wiki/Districts_of_Uganda>, and the
HealthMap/ProMED-mail interactive map of the country can be seen at
<http://healthmap.org/r/0gge>. - Mod JFW]

[In 2008, Lujo virus (LUJV), a new member of the family _Arenaviridae_
responsible for a severe haemorrhagic fever, was isolated in South
Africa during an outbreak of human disease characterized by nosocomial
transmission and an unprecedented high case fatality rate of 80
percent (4/5 cases). This virus was characterised molecularly and
found to be an arenavirus distinct from previously known Old World
arenaviruses (such as Lassa fever virus).

In September and October 2008, 5 cases of this previously undiagnosed
haemorrhagic fever, 4 of them fatal, were treated in South Africa
after transfer of a critically ill index case from Zambia. This highly
lethal virus has not been recorded subsequently elsewhere in Africa,
but Lujo virus should be considered as a possible etiologic agent in
the current outbreak of undiagnosed haemorrhagic fever in Uganda. That
apart, the methodology of unbiased high throughput pyrosequencing
(see:
<http://www.plospathogens.org/article/in ... at.1000455>) developed by Ian Likkin and colleagues for the initial characterisation of the highly lethal Lujo virus could be applied with profit in the current disease situation in Uganda. -
Mod.CP]

[Hemorrhagic fevers are spread by arthropods or contact with body
fluids or excreta of infected humans and animals, not by handshake. -
Mod.JW]

[Birgitt]

BLISTER BEETLE (NAIROBI FLY) - LIBERIA: (GRAND CAPE MOUND) REQUEST FOR
INFORMATION
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Date: Tue 23 Nov 2010
Source: The Inquirer [edited]
<http://theinquirer.com.lr/story.php?rec ... 263&sub=14>


Skin disease spread in Grand Cape Mount County
----------------------------------------------
As the wild spread of the contagious skin disease takes over the city of
Robertsport in Grand Cape Mount County [Liberia] the Ministry of Health and
Social Welfare has warned people with the disease to cease all movement to
avoid spreading the disease.

A recent visit by this paper to the county observed that the number of
victims has increased. Latest report has it that over 75 people are
infected with the skin disease. Liberia's deputy chief medical Officer Dr
Moses Pewu told "The Inquirer" that research done to determine the cause of
the disease at the Liberia Biological and Medical Research Center in
Margibi County shows, that the disease is caused by a fly called "Nairobi fly".

They said the disease was first discovered in Kenya in the city of Nairobi
and it was how the name Nairobi fly was given to it. Liberia is the 3rd
country to report the outbreak of the disease. It is reported that it was
once reported in Sierra Leone. Dr Pewu advised that to manage the wide
spread of the disease residents should consider strongly good health practices.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Beetles of the genus _Paederus_, known in East Africa as Nairobi fly,
cause an acute, painful toxic epidermolysis when crushed on skin (Fox R.
Paederus (Nairobi fly) vesicular dermatitis in Tanzania. Trop Doct. 1993;
23(1): 17-9 and Poole TR. Blister beetle periorbital dermatitis and
keratoconjunctivitis in Tanzania. Eye (Lond). 1998; 12(Pt 5): 883-5). - Mod.EP

More information on the _Paederus_ beetles including a photograph can be
found at <http://en.wikipedia.org/wiki/Nairobi_fly>.

Maps of Liberia are available at
<http://www.lib.utexas.edu/maps/africa/l ... l_2004.jpg> and the
HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/0hdW>. -
Sr.Tech.Ed.MJ]

[Birgitt]

ALKHURMA VIRUS - ITALY ex EGYPT
*******************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 26 Nov 2010
Source: Environmental Health Threats Forum [edited]
<http://www.eht-forum.org/news.html?file ... =home&id=0>


The 1st cases of Alkhurma haemorrhagic fever to be seen outside Saudi
Arabia are reported online in the December 2010 edition of Emerging
Infectious Diseases (1). Fabrizio Carletti and colleagues indicated that 2
people who visited a camel market in Egypt at different times during 2010
developed symptoms of the disease after returning to Italy. "The detection
of 2 independent infection events for travelers who visited the same area
in a restricted period strongly supports the hypothesis of sustained local
ALKV [Alkhurma virus] circulation," write the authors.

The virus, which is classified as a high-biosafety pathogen, infects camels
and sheep. Most human cases of Alkhurma haemorrhagic fever are seen in
butchers, who are more likely to come in contact with contaminated blood of
an infected animal. But people can also catch the virus through the bite of
an infected _Ornithodoros savignyi_ tick or by drinking unpasteurised milk.

The disease is fatal in about 25 per cent of patients. It was discovered in
the mid-1990s and named after the city where the 1st fatal case occurred.
About 40 cases have been reported since then, never outside Saudi Arabia.

The 1st case of imported disease described by the authors, a 64 year old
man, told doctors that he got bitten on the foot by what looked like a tick
while visiting a camel market in April this year [2010]. Within 2 days
after the bite, he developed a high fever, chills, and nausea among other
symptoms. On returning to Italy, his condition worsened, but he was
discharged from hospital in mid-May 2010 after successful treatment.

In the meantime, blood samples were sent for testing to discover the cause
of his illness. Initial tests ruled out dengue and West Nile viruses, but
after suspecting that a flavivirus might be involved, medical scientists
used genus-specific reverse transcription-PCR to identify genetic material
very similar to that of the Alkhurma virus.

Weeks later, blood samples from another patient also tested positive for
the virus. The 2 patients visited the region around one month apart.

Carletti and colleagues call for future research to determine how far the
virus has spread in the region, and to weigh up the risk to locals and
visitors. But the virus should now be added to the list of travel-related
pathogens under surveillance, they say, and travellers should be advised
about the risks of coming in contact with animals in endemic areas.

In the same issue of the journal, scientists probing risk factors for
Alkhurma haemorrhagic fever in the Saudi city of Najran report (2) that
some people exposed to the virus develop symptoms that are too mild to be
detected as clinical illness. Abdullah Alzahrani and colleagues say this
suggests that only severe cases may have been recorded so far, artificially
increasing the case-fatality rate for the disease.

The finding also points to the possibility that the virus may circulate
more widely than previously thought, according to the authors, in other
parts of Saudi Arabia or in other countries. "The history of the reported
disease in Makkah [Meccah] during the Hajj, when thousands of livestock are
imported to Saudi Arabia, and the existence of the outbreak in Najran,
which is at the border with Yemen, necessitate further studies in adjacent
countries."

Alzahrani and colleagues draw their conclusions from an investigation into
28 cases of the disease identified in Najran city by active surveillance
between 2006 and 2009. For each patient, they selected 2 people who had no
antibodies against the virus and compared risk factors between the 2 groups
using survey data about their exposure history, clinical features of any
illness and demographic factors.

Backing results from previous studies, the analysis found that people were
more likely to contract Alkhurma virus by having contact with animals or
getting bitten by a tick, but not through unpasteurised milk or the bite of
mosquitoes, a suspected vector for the virus. The study also suggests that
living near a farm could be an additional risk factor for the disease.

References:
1. Carletti F, Castilletti C, Di Caro A, Capobianchi MR, Nisii C, Suter F,
et al. Alkhurma hemorrhagic fever in travelers returning from Egypt, 2010.
Emerg Infect Dis. 2010; 16(12) doi: 10.3201/eid1612101092.
<http://www.cdc.gov/eid/content/16/12/1882.htm>
2. Alzahrani AG, Al Shaiban HM, Al Mazroa MA, Al-Hayani O, MacNeil A,
Rollin PE, et al. Alkhurma hemorrhagic fever in humans, Najran, Saudi
Arabia. Emerg Infect Dis. 2010; 16(12). doi: 10.3201/eid1612.100417.
<http://www.cdc.gov/eid/content/16/12/1882.htm>

--
communicated by:
T J Allen <tjallen@pipeline.com>

[This is the 1st report of Alkhurma virus infection outside of Saudi Arabia
and, as the above report and references suggest, this virus is more widely
spread geographically than previously thought. The virus and human cases of
encephalitis caused by it were 1st reported in Saudi Arabia in 1995. There
have been several more human cases reported there since then. The virus is
a flavivirus similar to another tickborne virus, Kysanur Forest disease
virus endemic in Karnataka state, India. One hopes that surveillance for
Alkhurma virus encephalitis will be intensified in similar ecosystems in
the Middle East, where the tick vector occurs. Interestingly, the above
report discounts consumption of raw camel's milk as a major risk factor for
Alkhurma virus infection compared to tick bite or contact with infected
animals. This too warrants further study, given common consumption of raw
camel's milk by people in this region.

A HealthMap/ProMED-mail interactive map of Egypt can be accessed at
<http://healthmap.org/promed/index.php?v=26.5,29.9,5>. - Mod.TY]

[Birgitt]

UNDIAGNOSED DISEASE - UGANDA: ACHOLI, REQUEST FOR INFORMATION
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 29 Nov 2010
Source: The Monitor, via allAfrica.com [edited]
<http://allafrica.com/stories/201011291952.html>


A strange disease has hit Kitgum, Abim, and Agago districts, killing 8
people and infecting a dozen others since Mon 8 Nov 2010. A Health
Situation Report of Fri 26 Nov 2010 puts the cumulative number of cases of
the disease [at] 32.

The disease, which some sources suspect to be the deadly Ebola [hemorrhagic
fever], was reported in Balang Village in Agago District early this month
[November 2010]. Other cases were found in Odiyo Village, while other cases
were reported in Patongo, in the same district.

The national professional officer of the World Health Organization based in
Gulu District, Dr Emmanuel Tenywa, said 19 people are currently admitted in
an isolation ward at Kalongo Hospital. He said those admitted experience
acute diarrhea, vomiting, and severe headache.

Dr Tenywa said in the report that a health worker at Kolongo Hospital
contracted the disease after a suspected patient vomited on her.

[byline: Sam Lawino]

--
communicated by:
Thomas James Allen <tjallen@pipeline.com>

[The districts of Kitgum, Abim and Agago in the Northern Region of Uganda
can be located in the map at
<http://en.wikipedia.org/wiki/Districts_of_Uganda>. This region of Uganda
is populated mainly by people of the Achol ethnic group and has suffered
frequent incursions of refugees from Sudan in the north.

In 2008, the region suffered an extensive outbreak of hepatitis E virus
infection causing some fatalities (see the ProMED-mail archived reports
below). The characteristics of the disease described in the current report
are poorly defined but not dissimilar from those experienced by patients in
the hepatitis E outbreak. Ebola hemorrhagic fever has been suggested as a
possible cause of the outbreak. While not implausible, hemorrhage as a
feature of the disease is not mentioned in the press report. Precise
information from the region would be welcomed.

The HealthMap/ProMED-mail interactive map of Uganda can be accessed at
<http://healthmap.org/r/0089>. - Mod.CP]

[Birgitt]

UNDIAGNOSED DISEASE - UGANDA (02): (KITGUM)
*******************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 29 Nov 2310
Source: AllAfrica, The New Vision (Uganda) report [edited]
<http://allafrica.com/stories/201011300096.html>


Uganda: strange disease spreads to Kitgum
-----------------------------------------
The mysterious disease affecting Agago and Abim districts has
reportedly spread to Kitgum. The [Ugandan] Health Ministry yesterday
[28 Nov 2010] said the disease had not been identified yet, but
medical officers had been giving people "supportive treatment". Dr
Issa Makumbi, the Ministry's head of disease surveillance, said the
Entebbe-based Centre for Disease Control was today [29 Nov 2010]
expected to release results from samples received last week.

In the middle of this month [November 2010], Ministry officials,
quoting preliminary laboratory results, identified the disease as
amoebic dysentery. Yesterday [28 Nov 2010], the ministry put the
death toll in Kitgum at 5. But Sr Grace Ogwang, the Kitgum district
disease surveillance officer, said 8 people died of the disease in
Kitgum. This brings the death toll in the 3 districts to 36. The
disease has also reportedly spread to Pader.

The Kitgum victims included a mechanic who was hurriedly buried at
the Kitgum Hospital cemetery on [Sun 28 Nov 2010] under the strict
supervision of medical personnel from the World Health Organisation.
Ogwang said [the deceased] had travelled to Wol in Agago district a
week before his death. He is suspected to have contracted the disease
there. Ogwang warned people against getting into contact with the
bodies of victims and to avoid handshakes, communal handwashing, and
sharing of food.

[Byline: Anne Mugisa, David Labeja]

--
Communicated by:
Thomas James Allen
<tjallen@pipeline.com>

[Since the previous press report from the region, the outbreak of
this unidentified disease has spread to include Kitgum and the
overall death toll has in creased from 32 to 36. 8 of the fatalities
have occurred in Kitgum. No further information is available yet
regarding the nature of the disease, other than that initially
amoebic dysentery was suspected, rather than any form of haemorrhagic
disease as rumoured previously. A precise diagnosis is awaited.

The districts of Kitgum, Abim, and Agago in the Northern Region of
Uganda can be located on the map at
<http://en.wikipedia.org/wiki/Districts_of_Uganda>.
The HealthMap/ProMED-mail interactive map of Uganda can be accessed at
<http://healthmap.org/r/0089>. - Mod.CP]

[Birgitt]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2010 (29)
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[The ongoing epidemic of cholera in Haiti is being covered separately
and can be found in the "see also" list below. - Mod.LL]

In this update:
Africa
[1] Dysentery, amoebic - Uganda (northeast)
[2] Cholera - Chad

*****
[1] Dysentery, amoebic - Uganda (northeast)
Date: Wed 24 Nov 2010
Source: The New Vision (Uganda) [edited]
<http://www.newvision.co.ug/D/8/16/739215>


Two more people in Agago district have died of [amoebic] dysentery.
This brings the number of people who have died of the disease since
the outbreak begun in October 2010 to 15. 3 other people have been
quarantined at Kalongo after presenting symptoms of the disease.

The district health officer, Dr Emmanuel Otto, said the 2 people, who
had been quarantined at Dr Ambrossoli Hospital in Kalongo town
council, died over the weekend [20-21 Nov 2010]. "All the 5 victims
are from Paimol sub-county, which borders Abim district," Otto said.

Last week [week of 15 Nov 2010], 13 people died of the disease, 5
from Paimol and Omiya P'Chua sub-counties in Agago district and 8
from the neighbouring Abim district, where the disease is said to
have originated.

The health ministry spokesman, Paul Kaggwa, recently said preliminary
laboratory tests revealed that the disease was [amoebic] dysentery.

[Byline: David Labeja]

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[Although not specifically stated in this report, the previous report
stated that the outbreak was due to amoebiasis rather than
shigellosis. - Mod.LL]

[Maps of Uganda can be seen at
<http://en.wikipedia.org/wiki/Districts_of_Uganda> and
<http://healthmap.org/r/00bX>. - Sr.Tech.Ed.MJ]

******
[2] Cholera - Chad
Date: Mon 29 Nov 2010
Source: UN Integrated Regional Information Networks (IRIN) News [edited]
<http://www.irinnews.org/Report.aspx?ReportID=91233>


In the village of Tchinfogo in southern Chad, men and women
repeatedly sprint along a dirt path, their tears mixing with sweat as
they wail. They go for about 30 m before running back and lying on
the tomb of a woman who days earlier, at the age of 28, died of cholera.

It is a mourning ritual of the Massa ethnic group, predominant in
this part of Chad, Tchinfogo residents told IRIN. Normally, they
said, people would also throw themselves onto the body, often hugging
and kissing it. But amid a cholera outbreak that as of 24 Nov 2010
had killed 166 people and infected 5787 across Chad, communities have
had to alter their mourning rites.

Government health agents and aid workers working round the clock to
treat cholera patients and educate people on how to prevent the
disease (left untreated it can kill within hours) must contend with
people's desire to visit and touch ailing loved ones, or the bodies
of those who have died.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The HealthMap/ProMED-mail interactive map of Chad can be seen at
<http://healthmap.org/r/009u>. - Sr.Tech.Ed.MJ]